Registration

1. Personal Details

*Family Name:

*First Name:

*Email:

*Date of Birth (MM/DD/YYYY) :

*Are you 18 or over?

Yes

No

Request custodianship document
*Emergency Contact Name:
*Emergency Contact Phone:

*Address:

*City:

*Province/State:

*Postal code:

*Country:

*Telephone:

Fax:

*Nationality:

*Mother Tongue:

*Gender:

M

F

*How long have you been studying the language?

years

*Oral self-evaluation :
(1=beginner 5= advanced)

1 2 3 4 5

*Written self-evaluation :
(1=beginner 5= advanced)

1 2 3 4 5

*Please tell us why you want to learn a second language.

*Have you completed any english exams?

Yes

No

*Which Exam ?
IELTS
TOEFL
TOEIC
Cambridge

*Have you attended a Centre Linguista Canada course before?

Yes

No

*Which school(s), and year(s) ?

*Where did you hear about Centre Linguista Canada?
representative
advertisement
guide
fair
internet
former student
Other:

2. Information for professional adults

*Are you a professional adult?

Yes

No

*Occupation :

Company / Organization name:

Telephone:

*Course objective(s):

	Technical Objective
	Business Objective
	General Objective
	Other Objective(s) :

Areas you wish to specialize in

Registration

Related links

Registration

1. Personal Details

2. Information for professional adults